Proposed rule would reduce red tape and streamline administrative processes to help children, older adults, people with disabilities, and others from underserved communities connect to health care coverage through Medicaid and CHIP 

The Biden-Harris Administration proposed a new rule to overhaul the enrollment processes for Medicaid, the Children’s Health Insurance Program (CHIP), and Basic Health Programs (BHPs), and eliminate arbitrary coverage caps for children in CHIP. In a Notice of Proposed Rule Making (NPRM), the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is working to reduce red tape and simplify application and verification processes to make it easier for children, older adults, and people with lower incomes with Medicaid and CHIP coverage to enroll in and retain vital health insurance. This proposed rule follows President Biden’s executive orders in April 2022 and January 2021 directing federal agencies to take action to expand affordable, quality health coverage, including by strengthening Medicaid and the Affordable Care Act.

Under the Biden-Harris Administration, thanks to the American Rescue Plan and other Administration efforts, more Americans than ever before have health insurance coverage. Today’s proposed rule will build on these efforts and support President Biden’s calls to strengthen Medicaid and access to affordable, high-quality health coverage.

“Medicaid and CHIP provide essential health care to millions of families across the country, and we are making it easier to enroll children and others in health insurance and to maintain coverage,” said HHS Secretary Xavier Becerra. “With these steps, we’re delivering on our promise to make high-quality health care more accessible and affordable for all Americans.”

“CMS is acting today to protect and strengthen health care coverage for the more than 88 million people enrolled in Medicaid, CHIP, and the Basic Health Program,” CMS Administrator Chiquita Brooks-LaSure said. “This proposed rule will ensure that these individuals and families, often from underserved communities, can access the health care and coverage to which they are entitled – a foundational principle of health equity. In addition, this proposed rule will help more people pay their Medicare premiums by making it easier for them to enroll in the Medicare Savings Programs.”

This rule, if finalized, would standardize commonsense eligibility and enrollment policies, such as limiting renewals to once every 12 months, allowing applicants 30 days to respond to information requests, requiring prepopulated renewal forms, and establishing clear, consistent renewal processes across states.

Medicaid and CHIP are critical sources of health care insurance for families across the country. Medicaid is the single largest health coverage program in the U.S., covering nearly one in four Americans and providing robust benefits with little to no out of pocket costs. Together, Medicaid and CHIP provide 51% of our nation’s children and youth – more than 40 million children – access to quality, affordable health care. However, enrollment in these programs can be jeopardized because of cumbersome application or renewal processes and lack of uniformity in states across the country. This NPRM takes aim at those concerns, and includes a suite of proposed options to provide easier access to and retention in health care coverage.

In a major transformation to the programs and a historic win for American families, the Biden-Harris Administration is proposing to end lifetime benefit limits in CHIP and allow children to enroll in coverage right away by eliminating pre-enrollment waiting periods, consistent with nearly all other health coverage. The proposed rule would also permit states to transfer children’s eligibility directly from Medicaid to CHIP when a family’s income rises, preventing unnecessary redetermination processes from causing lapses in coverage.

The NPRM proposes simplifications that would increase enrollment and retention for people age 65 and older, as well as those who have blindness or a disability. The proposed rule, if finalized, would streamline the application process for these programs by removing unnecessary administrative hurdles for people who do not have – but are eligible for – Medicaid, CHIP, or BHP coverage. These individuals are often eligible for Medicaid, but are not yet enrolled or have trouble staying enrolled because of systemic barriers, potentially missing life-saving coverage and care because of burdensome processes.

The proposed rule also includes policies that would improve access to programs that help make health coverage more affordable for older adults and individuals with disabilities. It offers ways to simplify enrollment for Medicare Savings Programs, which permit Medicaid to pay Medicare premiums or cost sharing for Medicare beneficiaries with lower incomes. The proposed rule would also allow for automatic enrollment in Medicare Savings Programs for certain individuals receiving the Social Security Administration’s Supplemental Security Income – a key goal for streamlining connections to care for those who need them most.

A recent study estimated that only about half of eligible low-income individuals enrolled in Medicare were also enrolled in Medicare Savings Programs. This proposed rule would automatically consider older adults for Medicare Savings Programs enrollment when they apply for low-income subsidies to help pay for Part D Medicare coverage, reducing the burdens of both time and expense by eliminating the need to complete multiple applications.

Lastly, proper documentation is critical to enabling appropriate oversight, identifying errors in state policies and operations, and reducing inconsistent and outdated practices across states, which contribute to improper payments. This proposed rule would update and standardize recordkeeping requirements for states, which would help to address deficiencies in outdated state recordkeeping systems and improve program integrity.

For more information on the NPRM, consult the fact sheet available at https://www.cms.gov/newsroom/fact-sheets/streamlining-eligibility-enrollment-notice-propose-rulemaking-nprm.

To review or comment on the NPRM during its 60-day public comment period, visit the Federal Register.

Suzanne BeHanna initially turned down an experimental but potentially lifesaving cancer treatment.

Three years ago, the newlywed, then 62, was sick with stage 4 lymphoma, sick from two failed rounds of chemotherapy, and sick of living in a trailer park near the University of Texas MD Anderson Cancer Center in Houston. It was fall 2019, and treatment had forced her to migrate 750 miles east from rural New Mexico, where she’d settled only months before her diagnosis.

Chimeric antigen receptor T-cell therapy might have been appealing to BeHanna if it were available closer to her home. But it is offered only at major transplant hospitals.

BeHanna had been living in Houston for six months, suffering through chemotherapy that made her feel awful and didn’t stop her cancer. She wanted to go home to die, but her husband wanted her to give CAR T-cell therapy a chance if her doctor would approve it.

The therapy uses a patient’s T cells, a key part of the immune system, to fight cancer. Dr. Michel Sadelain, an immunologist at the Memorial Sloan Kettering Cancer Center in New York and a pioneer of the therapy, describes it as “a living drug — a T cell which has been weaponized against cancer.”

The treatment uses a process called apheresis to extract T cells from the patient and then genetically modifies the cells to add a receptor, the chimeric antigen, which binds with the cancer cells.

Making CAR T cells takes about 10 days, but because only three companies — Bristol Myers Squibb, Gilead Sciences, and Novartis — have FDA approval to produce them commercially, receiving the cells back for infusion can take up to a month. Once in the patient’s bloodstream, the CAR T cells multiply, recognize cancer cells, and kill them. If the therapy works, the patient’s cancer is usually in remission within a month.

For about 10 years, oncologists have used CAR T-cell therapy in clinical trials for patients with blood cancers — including BeHanna, who has diffuse large B-cell lymphoma, and others with lymphoblastic leukemia and multiple myeloma. But until recently, it was FDA-approved only for those who had already had two unsuccessful rounds of more conventional treatment, like chemotherapy. For some types of blood cancer, the therapy leads to remission in more than half of patients. In April, for the first time, the FDA approved CAR T-cell therapy for lymphoma patients whose cancer recurred within 12 months after only one round of more conventional treatment.

That more people will be eligible for CAR T-cell therapy seems like good news, but Dr. Jason Westin, an oncologist at MD Anderson, isn’t immediately optimistic. Westin, chair of the American Society of Clinical Oncology’s government relations committee, is concerned that as more patients become eligible, the cost — $375,000 to $475,000 — will strain the ability of insurers to support it.

Read more.

After acknowledging that CDC’s Covid-19 response “did not reliably meet expectations,” CDC Director Rochelle Walensky called for an “ambitious” overhaul of the agency.

CDC faces criticism over public health emergency response

While CDC has faced criticism on its response to public health issues for years, public upset with the agency increased significantly during the Covid-19 pandemic. And dissatisfaction with the agency has continued into the monkeypox public health emergency as well.

Many experts believe the agency took too long to acknowledge the coronavirus’s spread from Europe to the United States, to recommend masking, to announce the virus was airborne, and to implement systematic testing for emerging variants, the Associated Press reports.

“We saw during COVID that CDC’s structures, frankly, weren’t designed to take in information, digest it and disseminate it to the public at the speed necessary,” said Jason Schwartz, a health policy researcher at the Yale School of Public Health.

In addition, many experts have criticized the agency for prioritizing the collection and analysis of data rather than taking steps to address emerging public health threats.

“CDC is a great organization, but it has always functioned like a big academic health system and not an emergency response entity,” said Georges Benjamin, executive director of the American Public Health Association. “And the world has changed a lot.”

On Wednesday, Walensky acknowledged CDC’s shortcomings in its pandemic response. “For 75 years, CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations,” Walensky said.

“It’s not lost on me that we fell short in many ways” responding to the Covid-19 pandemic, Walensky said. “We had some pretty public mistakes, and so much of this effort was to hold up the mirror … to understand where and how we could do better.”

Walensky calls for an ‘ambitious’ overhaul

In April, Walensky requested an in-depth review of CDC, which would help inform an “ambitious” overhaul of the agency, which CDC leaders are calling a “reset.”

“The goal was to learn how to pivot our long-standing practices and adapt to pandemics and other public health emergencies, then to apply those lessons across the organization,” Walensky said.

“As a long-time admirer of this agency and a champion for public health, I want us all to do better,” she said. ” … I feel like it’s my responsibility to lead this agency to a better place after a really challenging three years.”

“My goal is a new, public health, action-oriented culture at CDC that emphasizes accountability, collaboration, communication and timeliness,” Walensky added.

“For CDC to be more effective, we must build on the lessons learned from COVID-19 to improve how we deliver our science and programs,” Walensky noted, adding that this must include sharing scientific data and findings more quickly, and “translating science into practical, easy-to-understand policy.”

To accomplish the agency’s goals, Walensky said “there are some areas that will require a reorganization,” which include:

• Publishing preprint reports to quickly distribute actionable data, rather than waiting for research to undergo peer review and publication by CDC’s Morbidity and Mortality Weekly Report
• Reorganizing CDC’s communications office and improving the agency’s websites to make its guidance more accessible to the public
• Setting a six-month minimum CDC leaders can devote to outbreak responses to address a turnover problem that has resulted in knowledge gaps and miscommunications
• Creating a new executive council to help the CDC director determine the agency’s strategies and priorities
• Naming Mary Wakefield, who previously headed the Health Resources and Services Administration and served as the no. 2 administrator at HHS during the Obama administration, as CDC’s senior counselor to implement the proposed changes
• Notifying CDC’s organization chart to undo certain changes made during the Trump administration
• Creating an office of intergovernmental affairs to foster partnerships with other agencies
• Establishing a higher-level office on health equity

In addition, Walensky said she plans to “get rid of some of the reporting layers that exist, and I’d like to work to break down some of the silos.” While she did not go into further detail, she emphasized that the overall changes are more focused on rethinking how the agency conducts business and motivates employees, and less about redrawing the organization chart, AP reports.

“This will not be simply moving boxes” on the organization chart, Walensky noted.

While the reorganization proposal must be approved by the HHS secretary, CDC officials said they hope to have a finalized set of changes approved and implemented by early 2023.

From HealthcareDive

Dive Brief:

• About 17% of enrollees in Medicaid and the Children’s Health Insurance Program, or 15 million people, could lose their coverage when states resume regular eligibility checks once the COVID-19 public health emergency ends, HHS projected in a report from the Office of the Assistant Secretary for Planning and Evaluation.
• Loss of eligibility will require 9.5% of beneficiaries to transition to another source of health insurance, while nearly 8% will leave the program despite remaining eligible due to difficulty navigating the renewal process and other administrative issues, HHS reported.
• The agency said it is taking steps to reduce the risk of people becoming uninsured at the end of the public health emergency, including working with state and federal marketplaces to facilitate enrollment in other coverage options and stepping up outreach and education efforts. About 5.3 million children and 4.7 million young adults ages 18 to 34 are predicted to lose coverage. Of those, nearly a third are Latino and 15% are Black.

Dive Insight:

Health policy experts have been sounding the alarm about potential coverage losses for millions of Americans, including children, when pandemic protections expire. The nation’s uninsured rate fell to a historic low of 8% in the first quarter of this year, due in large part to the suspension of Medicaid coverage terminations that has swelled the number of participants in the program.

To help mitigate the disruption, the CMS issued guidance to assist states in November 2021 for transitioning those who will lose Medicaid and CHIP eligibility to other health insurance, such as subsidized plans, through Affordable Care Act marketplaces.

The extension of premium subsidies in the new Inflation Reduction Act is expected to improve access to alternative coverage for some losing Medicaid eligibility at the end of the public health emergency. The legislation extends enhanced marketplace subsidies until 2025.

Of those predicted to lose Medicaid and CHIP eligibility, 2.7 million people are expected to qualify for marketplace premium tax credits, the ASPE report said. Among this group, more than 60% are expected to qualify for zero-premium marketplace plans under the provisions of the American Rescue Plan. Another 5 million people are expected to obtain employer-sponsored insurance.

An estimated 383,000 people projected to lose Medicaid eligibility would fall in a coverage gap in the 12 non-expansion states because they have incomes too high for Medicaid but too low for marketplace tax credits.

Coverage losses due to administrative hurdles are also a high risk due to the volume of redeterminations that states must conduct and the length of time since Medicaid agencies last communicated with many beneficiaries, ASPE warned. The CMS is coordinating efforts with state Medicaid and CHIP agencies to minimize coverage lapses, the report added.

The Centers for Medicare & Medicaid Services (CMS) has released the “Supporting Health Care Resiliency” cross-cutting initiative (CCI), along with updated guidance to help health care providers prepare for the ending of the COVID-19 public health emergency. CMS is taking these steps to continue to protect people and restore standards for compliance with CMS requirements.

Please review the attached blog and below web links explaining the coming changes for each provider type and a CCI fact sheet.

Web links:

CMS Blog: https://www.cms.gov/blog/creating-roadmap-end-covid-19-public-health-emergency

CCI Fact Sheet: www.cms.gov/files/document/health-care-system-resiliency-fact-sheet.pdf

COVID-19 fact sheets for each provider type: https://www.cms.gov/coronavirus-waivers

Updated waiver document: https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf

From Becker’s Hospital Review

Citing a need to boost nurse hiring and retention, Pittsburgh-based Allegheny Health Network has launched a new mobile internal staffing model.

The new program, called Work Your Way, aims to provide greater work flexibility for nurses, surgical technologists and other employees, according to an Aug. 19 news release.

Eligible workers will cover rotational shifts in telemetry, critical care, perioperative care and emergency medicine at Allegheny General, West Penn, Forbes, Jefferson, Wexford, Canonsburg, Allegheny Valley and Saint Vincent hospitals. Options are available for external and internal applicants who prefer to work weekends and those who prefer night shifts.

Mileage will be reimbursed at 62.5 cents per mile for individuals in the program traveling more than 50 miles from their home, according to a frequently asked questions section on the health system’s website. Lodging will be reimbursed for individuals in the program traveling more than 75 miles from their home.

“The severe nursing shortage across the nation continues to affect all hospitals and health systems. Creating and executing innovative solutions helps us address the staffing challenge and at AHN we are doing just that,” Allegheny Health Network Chief Nurse Executive Claire Zangerle, DNP, RN, said in a news release. “Our new mobile internal staffing program is one of many solutions relative to the staffing challenges. It’s also an opportunity for nurses who are interested in joining AHN’s community of nursing in a unique way with competitive wages, excellent benefits and the flexibility of practice at different AHN hospitals.”

The new Allegheny Health Network program comes as hospitals and health systems across the U.S. are going beyond financial benefits to retain staff, offering more flexibility in terms of their work.

To learn more about the program, click here.

Whether you’re a seasoned or a rookie recruiter, you’ll benefit from the 2022 3RNET Academy. Thanks to the Pennsylvania Primary Care Career Center, rural facilities can attend for free. Register on the Pennsylvania 3RNET Academy page.

The academy kicks off Oct. 4, 2022 and runs every other week until Dec. 13, 2022, at 2:30 pm and is focused on the following topics:

• Session 1 – Guiding Your Recruitment for Retention Process – Practical Tools to Position Yourself as an Employer of Choice in Today’s Workforce Environment
• Session 2 – Planning and Preparation – Creating a Foundation for Success
• Session 3 – Marketing to and Finding Candidates – The New Normal
• Session 4 – Matching and Committing – Interviewing, Site Visits, and Closing the Deal
• Session 5 – Retaining for the Lifecycle of the Employee – Flexibility and Re-Recruiting
• Session 6 – 2022 Academy Wrap Up – Trends, Discussion, and Q&A with Industry Experts

Contact Judd Mellinger-Blouch, Director of the  Pennsylvania Primary Care Career Center, with questions.